Gastrointestinal reflux
Gastroesophageal reflux is a dysfunction of the lower esophageal sphincter that allows fluids to flow back from the gastrointestinal tract or food into the esophagus.
Different degrees of severity of esophagitis are the result of prolonged contact of gastric acid, pepsin, trypsin, bile salts and duodenal bicarbonate with the esophageal mucosa. The combination of insufficiency frequency and deficient mass determines the severity of esophagitis. If only gastric acid is active, then this leads to esophagitis. Moderately severe acid and combinations of pepsin or trypsin, bicarbonate and bile salts cause severe esophagitis. The risk of inflammation in the esophagus due to insufficiency of gastric acid increases with repeated hits compared to a long-term acid reflux. There are, of course, a few documented cases of esophageal reflux, of course this disease is more common than previously thought.
If complications occur, surgical intervention may be necessary. Pharmacological treatment: The treatment uses drugs that greatly reduce the production of gastric acid. In addition, prokinetic drugs are effective in combating reflux, but are less recommended for their cause. side effects include drowsiness and irritability; Surgical procedures: When drugs are inadequate and do not yield results, they are usually decided to perform the operation. Half of the patients still need medication after surgery. . When a child starts taking a shower, many parents immediately begin to think about a possible reflux.
reasons
Chronic vomiting, impaired gastric emptying, reduction of esophageal sphincter caused by esophageal hole and anesthesia are pathogenetic factors for gastroesophageal reflux development.
diagnostics
Clinical findings. The clinical symptoms of gastroesophageal reflux are similar to those of esophagitis. In severe cases, patients may survive: swallowing, overflow, swallowing, stretching of the head and neck during swallowing, and unwillingness to eat. However, in less severe cases, patients may only occasionally have a seizure failure, especially in the early morning hours. Such conditions occur as a result of the transition from the relaxed state of the esophageal sphincter during sleep. Physical examination of the patient usually does not give specific results, but fever and hypersalivation may be detected in patients with severe esophagitis.
And indeed - in many cases this problem is the basis of diseases. However, we are afraid? Gastroesophageal reflux is actually a set of symptoms that result from ingestion of stomach contents from the stomach to the esophagus. We call it utma swallowing da in children, and according to some sources it is a problem that affects more than 50% of newborns and infants.
When we talk about very young children, neonates and neonates, the problem is usually reflux caused by the normal maturation of the gastrointestinal tract. If the child does not have serious symptoms, serious measures are not taken to address this problem. He usually decides on the life of his own baby for a year, Dr. says Dr from the Krakow clinic in Krakow. Maria Stanis-Svolkin.
Diagnosis imaging. The diagnosis of gastroesophageal reflux should not be based solely on clinical deterioration findings. Survey X-ray is not informative. Video fluoroscopy may detect intermittent gastroesophageal reflux, but this phenomenon can also be seen in patients with normal esophageal function. Currently the best method of endoscopic examination is the diagnosis of mucosal inflammation associated with reflux esophagitis. The final diagnosis of esophageal reflux requires continuous measurement of the degree of contraction of the esophageal sphincter and continuous measurement of the 24-hour pH measurement in the lumen of the esophagus, that is, most patients cannot tolerate. Hiatus hernia, esophagitis and narrowing of the esophagus are the most important distinctive diagnostic symptoms for reflux.
It is noteworthy that the phenomenon of food ingestion calls failure. In most cases, reflux does not cause any deterioration in the child's development and is not a perceived source of pain. However, sometimes this happens differently - the baby rains a lot, additional symptoms are seen.
We have a bunch of symptoms that should be of interest to us. In infants, this occurs when a large amount of milk is spilled after each meal - this is also associated with a violation or even reduction in body weight. It is also important that parents pay attention to symptoms such as increased anxiety, apnea episodes, persistent cough or recurrent pneumonia. If our child is older, the following symptoms will be alarming: hoarseness, dry cough, pain when swallowed. Dr. Maria Stanis-Svolkin: Classic acid reflux symptoms should not be overlooked: heartburn, esophagitis, acid recoil and pain behind the breast.
Gastroesophageal Reflux Therapy
Since fat in food delays gastric emptying and reduces the pressure in the lower esophageal sphincter, patients should be fed with foods containing a limited amount of fat. Patient owners should also avoid feeding patients late in the evening because it helps to lower the pressure in the lower esophagus sphincter during sleep. In addition to dietary recommendations, rational drug therapy for such disorders includes the creation of barriers to diffusion of the stomach content (e.g., sucralfate), the inhibition of gastric acid secretion inhibitors (e.g., cimetidine, ranitidine, famotidine, omeprazole) and prokinetic drugs (e.g. metoclopramide). The creation of barriers to diffusion of gastric contents is perhaps the most important in the medical treatment of gastroesophageal reflux. For example, sucralfate protects the mucous membrane from damage during gastroesophageal reflux and promotes existing esophagitis healing. In addition, resistant reflux cases should be treated with gastric acid secretion inhibitors and / or prokinetic drugs. H, receptors, such as cimetidine, ranitidine, and famotidine antagonists, inhibit the secretion of gastric acid and reduce the amount of reflux. Omeprazole (an H, K + adenosine triphosphatase (ATP) inhibitor) can also be used to suppress the secretion of gastric acid. Low-dose erythromycin and metoclopramide may be effective in the treatment of gastro-esophageal reflux because they increase the pressure in the low esophageal sphincter. 5-hydroxytryptamine 4 (5-HT4) agonists, such as cisapride, also increase the tone of the lower esophageal sphincter; However, the sale of cisapride is prohibited by many international pharmaceutical companies.
If you notice such symptoms in your child, you have nothing to wait for - you should see a doctor. If we suspect a more severe form of gastroesophageal reflux, we do a lot of activities: clinical interview, physical examination and visualization examinations. However, a 24-hour pH meter is the gold standard in the diagnosis of gastrointestinal reflux.
It is worth explaining how the so-called PH metric passed. This is a procedure that examines the degree of acidification in the lower esophagus. Place two probes in the child to examine this element. The first enters the skin of the chest, the second enters the esophagus through the nose. It is then connected to a special device that measures both. With such a "multitude", the baby returns home with his family and writes when he writes. The device and probes were removed after 24 hours.
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Gastric reflux symptoms and causes
Some features
Diagnosis and treatment of reflux disease
Practical advice
A disease such as gastric reflux means that the contents of the digestive tract are transported back from the sphincter to the esophagus.
Advanced diagnostics are not necessarily required - fortunately - in most cases. We usually talk about reflux, which never threatens the child's health. This, of course, does not mean that the casting problems should be left to yourself. We recommend how to reduce its frequency.
After each meal, carry the child upright on his shoulder - thanks to this little child, it will be easier to squeeze and squeeze less milk. Therefore, place the cap so that it is slightly higher than the rest of the body. However, do not use pillows - instead, place some books under the bed or take a special wedge. Try to feed your baby more often if possible, but take less.
A baby in the crib may suffocate from the stomach.
When the baby is too heavy, you can thicken.
To do this, consult your pediatrician and ask for a better compression agent.
This is a drug that should prevent overflow.
Gastroesophageal reflux disease, called gastroesophageal reflux, is the flow of gastric contents in the opposite direction to the esophagus.
The fact is that inflammation occurs when the acidity in this disease shifts and the mucous membrane is in contact with the acidic contents in the stomach and the digestive enzyme for a long time. Also, the so-called bicarbonates duodenum. Therefore, the disease should be eliminated immediately to avoid serious consequences.
How does reflux esophagitis occur?
The mucous membrane of the esophagus becomes irritated with acidic gastric juices. The most common symptom of reflux is heartburn. A properly functioning lower esophageal sphincter swells when food is swallowed and contracts when it enters the stomach. When this sphincter is ineffective or abnormal, gastric acids can return to the esophagus called gastroesophageal reflux disease.
Symptoms of gastroesophageal reflux disease
The main symptoms are heartburn, pain and burning in the chest, sometimes spread to the neck and chin. Heartburn occurs mainly immediately after a meal. Typical symptoms of acid reflux include a feeling of insufficiency of the stomach content in the esophagus or acid reflux. Often, despite oral hygiene, people are accompanied by bad breath or excessive saliva. This is because the esophagus is cleaned by excess stomach acids. When these symptoms are accompanied by changes in the esophagus, the condition becomes more serious: hoarseness, dry cough and gingivitis.
Gastric reflux symptoms and causes
In some cases, reflux is considered a normal physiological manifestation. This can be the norm, especially if the person starts after eating, and if this phenomenon does not cause discomfort, its duration and frequency are insignificant, especially at night.
How is gastroesophageal reflux disease prevented?
The most dangerous is the emergence of odnogogii, dysphagia, bleeding and even weight loss. Diseases usually worsen after heavy eating and twisting. In children, the main symptom is unwillingness to eat. Avoid sharp and heavy dishes. You should also reduce smoking, drinking coffee, alcohol and food. The last meal should be eaten 3 hours before bedtime. People with excess weight problems should reduce their weight. Drinks contain milk and alkaline water is recommended. calcium that reduces symptoms of a large number of reflux diseases.
However, this disease can be painful, especially if it occurs frequently enough and persists for a long time, if these symptoms develop while gastric contents are excreted into the esophagus, events of the disease may occur both day and night, Clinically inflammation occurs or esophageal mucosa is damaged . This may be due to insufficiency of the sphincter, which occurs in the stomach and is due to adequate reflection or painful changes, but also increases the severity of reflux.
How is GERD treated?
The main method of reflux therapy is pharmacological therapy. During the disease, medications are added to increase the tension of the lower esophageal sphincter. It destroys hydrochloric acid and reduces the formation of gastric juice. Also, prescription drugs for alkalization. Liquid forms protect the esophageal mucosa against irritation. If after medication treatment no improvement, surgery is required. Surgery is used for acute esophagitis and severe bleeding.
Especially those who are susceptible to this disease, overweight people suffering from diabetes or suffering from abdominal cavity in high pressure hormonal disorders and pregnant women. Reflux adversely affects the use of certain medications, such as birth control pills, nitrates or calcium channel blockers. Violations may also cause normal analgesics such as polypyrin or aspirin. Reflux can cause respiratory irritation, vocal cords, and pulmonary complications.
Moreover, in patients with this disease, as a rule, reduced pressure in the esophagus sphincter. Experts have found that special attention should be paid to hormonal factors to maintain sphincter tone. Special medicines and products can reduce pressure. They develop and protect reflux.
Infusion of infants is often a common problem with age. Unfortunately, sometimes it gets more serious and goes by after drinking milk and then after eating. These symptoms may persist in the first year of life in the child and may remain for even longer, slowing down the child's development, leading to many unpleasant consequences. However, is this a gastroesophageal reflux that needs to be treated? How do you behave when you see the symptoms listed above?
Gastroesophageal reflux in children, or what?
In children, gastroesophageal reflux is caused by the immaturity of the lower esophageal sphincter, which causes the gastric contents to flow in the opposite direction to the esophagus.
How do you worry about gastroesophageal reflux in children?
Symptoms of gastroesophageal reflux in adults may be difficult to diagnose in children.
Because the sphincter in the abdominal cavity is under the diaphragm, it prevents the gastric contents from being thrown into the esophagus during respiration. Under normal circumstances, the lower part of the esophagus between the legs of the diaphragm is clamped. If a patient has a hernia, the diaphragm slides, which prevents the release of acidic content.
How is gastroesophageal reflux diagnosed in children?
In the youngest children, gastro-esophageal reflux is often associated with the consequences of vomiting, ie, slow weight gain - the child grows more slowly, usually restless, irritable, less often wakes up and becomes more difficult to calm down. The child is smooth, irritable, has a small appetite, grows slowly, sleep apnea, bad breath, sore throat, hoarseness, often recurrent pneumonia, wheezing. Babies have problems such as sleeping, crying, restlessness, hiccups, developmental abnormalities and Sandifer syndrome. older children have problems with their teeth, enamels and cavities. It is diagnosed on the basis of gastroesophageal reflux symptoms in children.
The esophagus can be reduced, so that the body is purified from its natural acidic content and esophageal acidity returns to normal. There are several mechanisms for cleaning the esophagus, especially because the esophagus itself has a long activity and a process such as saliva. If at least one of these phenomena is disturbed, the level of cleaning of the esophagus decreases. Usually this is caused by an alkali or acidic substance.
The disease can be confirmed empirically. However, if the symptoms are atypical, leave doubts and if the treatment does not produce the expected results, further investigation may be necessary and find the cause of the problems. Sometimes esophageal manometry, pendendoscopy, biopsy for damage assessment, radiological examination and so on. It must be done.
Gastroesophageal reflux therapy in children
Gastroesophageal reflux therapy should aim to reduce gastric acid secretion as well as accelerate gastric emptying time to make digestion more effective. Frequent feeding of the child, but placement of the child in small portions after feeding, raising the pillow, so that the child is slightly longer may be useful.
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Some features
Talking about symptoms, reflux disease has, as a rule, several symptoms that are not only observed in isolation, but also in some combinations. It should be noted that these symptoms occur in 40% of people from different parts of the world and that 10% live every day.
Gastroesophageal reflux disease is characterized by the dissolution of the acidic content of the stomach into the esophagus. This can occur physiologically in healthy people and does not cause discomfort or changes in the esophagus tissues. However, when complaints are accompanied by complaints or complications, we are talking about pathological reflux reflux disease, one of the main symptoms of heartburn.
Many times a day, the pressure in the abdominal cavity exceeded the pressure in the esophagus. These are situations where the contents of the stomach enter the esophagus most frequently if our body does not have a specific physiological defense mechanism. One of the most important is the lower sphincter of the esophagus - a muscle with a functional structure is part of the muscle layer of the circular esophagus. Under resting conditions, tonic is in contraction state. However, it temporarily relaxes during swallowing, the reaction of the body that allows the free food bolus to enter the stomach.
The most prominent findings are heartburn, pain on the left side and behind the sternum. Some of them often suffer from inadequacy, pain during swallowing, long-term cough and deterioration of tooth enamel.
It should be noted, however, that these symptoms do not fully reflect the severity of the disease. In most cases, reflux disease is not accompanied by any sensation.
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Diagnosis and treatment of reflux disease
Any changes in reflux in the esophagus can be evaluated by biopsy. Not only does it assess the esophageal lesion, it also makes a differential diagnosis, and this is all due to x-ray examination.
Acidity monitoring takes 24 hours and plays a crucial role in deciding the correct diagnosis.
Treatment primarily aims to reduce the severity of the disease, stomach content and affect the properties that affect welfare. In addition, it is necessary to improve the cleanliness of the esophagus and protect the mucous membranes.
It is important to follow general guidelines that can reduce the severity of spillage of stomach contents directly into the esophagus. Above all, it is the normalization of the patient's weight (performance improves with an appropriate diet in patients suffering from overweight). In addition, you should stop smoking and try to drink less alcohol, limit yourself to sweet, fatty foods such as chocolate, coffee is forbidden because these are products that reduce the sphincter tone, and fatty foods reduce stomach activity.
Sour food will also have to be abandoned, because it can cause an unpleasant phenomenon, such as heartburn.
Food should be in small portions and should be made regularly.
You should not eat at night, at least 2 hours before bedtime. Avoid excessive loads as this increases intra-abdominal pressure.
If such preventive measures do not provide any benefit, the doctor prescribes antacids. The so-called drugs include magnesium, aluminum salt and calcium. They neutralize hydrochloric acid. In addition to this effect, they have a binding effect, thanks to which there is a reduction in the digestive enzyme, lysolecithin and bile acid of gastric juice.
It is best to affect the disease preparations in the form of gels. In the esophagus, in the stomach, this tool produces small drops that increase the effect of the drug.
Antacids should be taken half an hour before meals and should be done before bedtime. It is recommended to take the remedy in supine position, should be done with small sips. If antacids are ineffective and symptoms persist, the patient is prescribed prokinetic or antisecretory drugs. In prokinetics, domperidone is administered to reflux patients. This drug should be consumed 10 mg, should be done 4 times a day.
If the patient has erosive esophagitis, additional treatment is prescribed. The most common prescription is rabeprazole and omeprazole.
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